[ECG for non-competitive sports in childhood: strengths and disputes]. / ECG per l'idoneità all'attività sportiva non agonistica in età pediatrica: punti di forza e controversie.

BACKGROUND: Sport is very important for health promotion and conservation. Active lifestyle and regular exercise reduce cardiovascular disease incidence. The Italian Ministry of Health issued the Law Decree no. 243 (10/18/2014) concerning "guidelines for certification about non-competitive sports" to promote safety in sports. This regulation defines the activities for which a certificate is required, the professional actors involved and the clinical exams to be performed according to the patient's health status. In particular, the Law Decree recommends to perform an electrocardiogram (ECG) "at least once in a lifetime", introducing much greater news into pediatric practice. METHODS: We proposed a survey evaluating frequency of ECG implementation for non-competitive sports and cardiovascular diseases incidence was administered to 7 Ligurian pediatricians. RESULTS: The number of ECG/year for pediatrician increased from 10 ECG/year to 50 ECG/year with an indication of suitability to non-competitive sports. One case of QT prolongation and 2 cases of type 1 Brugada ECG pattern were diagnosed. In addition, 3 patients had an atrial septal defect and 3 children had a ventricular septal defect. Forty-three percent of the pediatricians considered useful performing the ECG. CONCLUSIONS: ECG in children has enhanced the positive effects on the community health. However, it remains to be defined in agreement with scientific societies the age at which to perform ECG, the sports for which ECG is required and the cost-benefit ratio for the National Health System and families.

High Levels of beta-D-glucan in immunocompromised children with proven invasive fungal disease.

The plasmatic levels of 1,3-beta-d-glucan (BDG) were >523 pg/ml in 4 children, 2 low-birth-weight neonates and 2 stem cell transplant recipients, with the following invasive fungal diseases (IFD) proven apart from this BDG test: 3 cases of Candida parapsilosis candidemias and 1 case of disseminated aspergillosis. The BDG test may be useful for identification of IFD in pediatrics.

Cost analysis of an Italian neonatal hearing screening programme.

AIM: The objective of this study was to estimate the cost of a Universal Neonatal Hearing Screening (UNHS) programme in an Italian region. METHODS: A cost analysis of a regional UNHS programme was carried out on 32,502 newborns. 31,992 (98.4%) were no audiological risk (NAR) subjects and 510 were babies with audiological risk (WAR) (1.6%). UNHS was performed on two levels. The first level involved otoacustic emission (OAE) testing on NAR subjects, while the second level involved auditory brainstem response (ABR) testing of WAR and of NAR with 2nd OAE Refer tests. RESULTS: The cost of screening was 13.32 euro per screened NAR infant. The total cost (OAE+ABR) was 16.58 euro, spreading the cost over the whole NAR population. The total cost per screened infant in the WAR population was 415.9 euro. The average cost per detected case in the NAR population was 32,951 euro, while in the WAR population it was 11,303 euro. CONCLUSIONS: The cost of UNHS in our region is comparable to the cost per diagnosed case of other neonatal screening programmes, and it is justified when it allows us to intervene at an early stage. On the basis of both the cost of our regional screening programme and the incidence of hearing impairment, we can conclude that the cost-effectiveness of our programme has been demonstrated.